WHO decries global burden of healthcare-related infections

May 5, 2011 (CIDRAP News) – Calling for more effort to prevent healthcare-associated infections (HAIs), the World Health Organization (WHO) said today that untold millions of people suffer from them every year, with the burden falling most heavily on developing countries.

Although accurate global estimates are not available, "there is clear evidence that hundreds of millions of patients are affected every year worldwide, with the burden of disease much higher in low-and middle-income countries," the WHO said.

The agency released a 40-page report on the problem today in conjunction with a special emphasis on the importance of hand hygiene. The report is based on systematic reviews of the literature on endemic HAIs from 1995 to 2010.

Of every 100 hospitalized patients, 7 in developed and 10 in developing countries will acquire at least one HAI, the WHO said in a fact sheet released with the report.

More precisely, the estimated prevalence of HAIs in developed countries, on the basis of pooled results from national and multicenter studies, is 7.6%, the agency said. The estimated incidence in the United States was 4.5% in 2002, while the European Centre for Disease Prevention and Control has estimated that 4.13 million patients in Europe have an HAI every year, according to the report.

The WHO says HAI data from developing countries is very scanty, but many studies point to higher rates than in wealthy countries. Studies have shown prevalence levels ranging from 5.7% to 19.1%, with a pooled prevalence of 10.1%. Pooled high-quality studies indicate higher rates than low-quality studies: 15.5% versus 8.5%.

The risks are highest in intensive care units (ICUs), according to the WHO. In high-income countries, about 30% of ICU patients acquire at least one infection, and the rate is at least two to three times as high in low- and middle-income countries, the fact sheet states. It adds that device-related infections in ICUs are up to 13 times more common in developing countries than in the United States.

Surgical site infections are the most common type in developing countries, whereas urinary tract infections are most common in developed countries, according to the report. Pooled data point to an incidence of 11.8% for surgical site infections in the developing world, versus between 1.2% and 5.2% in wealthy countries.

The report also says that newborn babies in developing countries are 3 to 20 times more likely to have an HAI than are newborns in high-income countries.

The WHO asserts that efforts to reduce the burden of HAIs must focus first on learning more about the problem: "There is an urgent need to establish reliable systems for HCAI [HAI] surveillance and to gather data on the actual burden on a regular basis. Evaluation of the key determinants of HCAI is an essential step to identify strategies and measures for improvement."

The report adds that there is strong evidence that the burden of HAIs can be reduced by 50% or more. "HCAI must be treated as a priority patient safety issue within comprehensive approaches to be tackled effectively," it says.